Achilles Tendinopathy

Achilles Tendinopathy

What is Achilles Tendinopathy?

Achilles Tendinopathy refers to pain and stiffness of the Achilles tendon. The Achilles tendon is fibrous tissue that connects the soleus, gastrocnemius & small plantaris muscle to the calcaneum (heel bone). Through the Achilles tendon, their combined actions are to plantarflex the foot OR when the foot is on the floor, raise the heel. The majority of the Achilles tendon is derived from the soleus muscle (two thirds) and it consists largely of strong Type-I collagen with small amounts of weaker Type-III collagen. When an area is damaged / injured, fibroblasts enter the area and form Type-III collagen rich granulation tissue which, with time and the correct stimulus, will further synthesise into the tougher Type-I collagen.

What causes Achilles Tendinopathy?

Achilles tendinopathy most commonly occurs as a result of one of the following:

Overuse – a sudden change in the loading of the tendon, for example when someone suddenly decides that they are going to start running and sets off with the wrong footwear and for too far!

Inappropriate Footwear – wearing ill-fitting, non-supportive footwear OR footwear not made for the task can also place an abnormal load on the Achilles tendon.

Misalignment – foot positioning, knee alignment, post-surgery to the lower limb, low back pain and anything else that may cause an individual to walk awkwardly can eventually lead to a Tendinopathy.

Some clients may report the development of Achilles Tendinopathy symptoms without any of the above being present but management should remain the same.

Management of Achilles Tendinopathy

Extensive research has been conducted on the best management of Achilles Tendinopathy and despite the large majority of it related to animal tissue, the conclusions are similar ...

• Relative rest from aggravating activity
• P.R.I.C.E. – (Protection, Rest, Ice, Compression & Elevation)
• Graduated ECCENTRIC loading programme

 Pilates & Achilles Tendinopathy

Pilates in my opinion should be the Gold Standard for the recovery of Achilles Tendinopathy! Although clients are unlikely to be referred to you because of Achilles Tendinopathy, if a client develops it, you have ALL the correct tools to manage the recovery.

As the instructor, you would have initially assessed the posture of your client taking note of the entire Kinetic Chain of the lower limb. In these cases don’t be surprised to find weak pelvic stabilisers, tight hamstrings and either weak or tight calves (soleus & gastrocnemius). Then simply address what you find from assessment whilst adding a graduated ECCENTRIC programme.

 Eccentric Programme

Every client will present differently so there is NO DEFINITIVE programme to employ. BUT use your common sense. If the client is struggling to walk stairs (usually worse going down than up) then starting in weight-bearing may be too much too soon. In this case the good old ‘Footwork’ series on the reformer is ideal where you can monitor overall leg alignment and use the bar or footboard to better control eccentric loading. Even better, using a reformer will allow you to adjust tension, work with knees straight and bent (thereby addressing ALL the calf muscles – IMPORTANT!) and continue cueing the importance of moving from a stable centre.

If you do not have access to a reformer (as most clients won’t!) then consider the use of a horizontal leg-press machine in the local gym OR use your imagination with a Gym Ball on the wall!

When the client can perform non-weight bearing ECCENTRIC loading without pain they can progress to weight bearing activities and continue to employ the principles of a strong centre and good lower limb alignment. At this stage the classic heel drops into calf raise are best BUT again consider which muscle groups you are targeting and make sure to monitor alignment.

For the Achilles to return to normal the client will need to perform exercises that are;

• ECCENTRICALLY loading the Achilles
• Slow in pace
• Into pain and discomfort
• Aiming for 200 reps throughout the day

This may seem harsh but unfortunately, rehabilitation of Achilles tendinopathy SHOULD be painful! Pain needs to be experienced DURING the exercises but not continue to be present 30 minutes afterwards. In order for the Achilles to return to its full function, restoring Type-I collagen, stimulation of the right cellular activity has to occur. Research has shown that an increase in loading (within reason!) of the tendon encourages this process.

 ** WORTH KNOWING **

Even with the correct advice and exercises, Achilles Tendinopathy can take 8 weeks or more to fully recover!!

By Robert White MSc MCSP (April 2010)

PLEASE NOTE: The content of this article is written merely as an opinion by the author and is by no means to be received as a clinical guideline. Opinions written are solely those of the author and as such Pilates Union UK does not accept any responsibility for actions taken as a result of reading this content.